BACKGROUND AND PURPOSE: Telestroke networks offer an opportunity to increase tissue-type plasminogen activator use in community hospitals. METHODS: We compared 83 patients treated with intravenous tissue-type plasminogen activator by telestroke to 59 patients treated after in-person evaluation by the same neurologists at a tertiary care stroke center. Onset and door-to-treatment times and functional outcome at 90 days were obtained prospectively. Favorable outcome was defined as modified Rankin Scale score ≤2. RESULTS: Favorable outcome rates were comparable between the groups (42.1% versus 37.5%, P=0.7). There was no significant difference in the rate of symptomatic hemorrhage. CONCLUSIONS: Telestroke is a viable alternative to in-person evaluation when stroke expertise is not readily available.